ADecrease in Glucose Variability Does Not Reduce Cardiovascular Event Rates in Type 2 Diabetic Patients After Acute

OBJECTIVE—To assess the effect of intraday glucose variability (GV) on cardiovascular out-comes in a reanalysis of Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) study data. RESEARCH DESIGN ANDMETHODS—Type 2 diabetic patients after acute myocar-dial infarction were randomized to an insulin treatment strategy targeting postprandial (PRANDIAL; n = 557) or fasting/interprandial (BASAL; n = 558) hyperglycemia. GV was calcu-lated as mean amplitude of glycemic excursions (MAGE), mean absolute glucose (MAG) change, and SD. RESULTS—The PRANDIAL strategy resulted in an 18 % lower MAG than BASAL (mean [SEM] difference 0.09 [0.04] mmol/L/h, P = 0.02). In addition, MAGE and SD were lower in the PRANDIAL group, however, not significantly. HbA1c levels and cardiovascular event rates were comparable between groups. CONCLUSIONS—A PRANDIAL strategy demonstrated lower intraday GV vs. a BASAL strat-egy with similar overall glycemic control but did not result in a reduction in cardiovascular outcomes. This does not support the hypothesis that targeting GV would be beneficial in re-ducing subsequent secondary cardiovascular events. Diabetes Care 34:855–857, 2011 Short-term variation in blood glucose(BG) levels is a daily challenge forpatients with diabetes. It confers a possible increased risk for hypoglycemia, and it has been suggested that glucose variability (GV) is related to cardiovascu-lar risk (1–3). However, reanalysis of the Diabetes Control and Complications Trial (DCCT) and DCCT/Epidemiology of Di